Sep 2 End HIV by 2020? Tell Us ‘How’

As someone who has dedicated her young life to learning how best to combat the HIV/AIDS epidemic, I am struck by articles wherein there is little thought given to the ‘how’ or ‘why’ we can fight HIV/AIDS. Instead, there is more focus on ‘what’ is needed or lacking in our armament. It seems to me that we are quick to judge ‘what’ is not working in the HIV intervention realm: treatments are failing, equipment lacks luster, drug stocks are insufficient. Yet there is little talk of ‘how’ to mitigate these challenges and ‘why’ such tribulations arise in the first place. It is about time that someone started talking about the ‘how’ and ‘why’ – maybe then we can rally behind the 90-90-90 Targets that I believe so deeply in.

Last week, BBC News published: “HIV effort let down by test shortages, says WHO,” wherein the writer discussed “gaps in provision” vis-à-vis rolling out HIV medications for global treatment. The article referenced the UNAIDS 90-90-90 Targets: by 2020, 90% of all people living with HIV should know their HIV status, 90% of those diagnosed should receive antiretroviral therapy, 90% of (these) treated patients should be virally suppressed. Viral suppression is a measure of inactivating the HI virus such that the probability of reinfection is mitigated. Within the article, one Vincent Habiyambere (Senior Procurement and Supply Management Office, World Health Organization) is quoted for claiming that “low and middle-income countries, including African countries where the HIV burden is high, are not geared up” for the fight against HIV/AIDS. Habiyambere implied that such countries lacked necessities to fight HIV such as staff training and properly installed equipment. Furthermore, laboratories and machines needed for testing and treatment were poorly maintained.

The article called for “strong leadership, resources, planning and management” as tools to implement and provide HIV services. Yet, there was little mention of ‘how’ to provide these tools in countries where most victims of HIV/AIDS are living below the poverty line.

Contrastingly, in her article “Are Young South Africans ignoring the Aids message?” (BBC News on 18th July 2016), Karen Allen described the plight of South Africans: “when the rest of the world was rolling out a drug called Nevirapine to reduce the chances of mothers transmitting the virus, South African leadership famously advised patients to use lemon and garlic, instead, to protect themselves.” Allen neglected to mention that the Nevirapine drug was sold for close to $100 per pill, especially since it was founded in 1996 and shortly approved by the FDA in the USA – a country far removed from South Africa in both distance and wealth at the time.

The drug embodied a luxury that most South African mothers could not afford. Hence the leadership turned to a more reasonable ‘home-remedy’ in garlic. While I openly admit this was likely less effective, I am reminded that this was at least presented a viable mode of action. Interestingly, we see that Allen honed in on the ‘what’ (lack of Nevirapine advocated in South Africa) while easily ignoring the ‘how’ and ‘why’ that I attempt to explore by means of the cost price of the drug.

Allen goes on to talk about a new plight in South Africa – the “sugar daddy syndrome.” She maintains that there are a number of young people who are newly infected with HIV due to intergenerational sex: sex across age groups. Needless to say the dim picture that Allen paints includes gender violence and inequality. While these are harsh realities in South Africa today, I believe that there is more achieved in highlighting the strides made against these social challenges instead of adding to the noise, which echoes their existence.

In the conclusion of her piece, Allen alludes to what I believe is the root of the epidemic that is crippling our nations - HIV stigma: “400 people die in South Africa every single day of HIV-related illnesses, either because they don’t seek help early on or default on their treatment.” The country is not alone given that more than “2 million adolescents” live with HIV globally (UNICEF 2016).

I am a graduate student who researches HIV/AIDS in South African urban townships. I believe HIV stigma embodies the ‘why’ surrounding HIV treatments specifically in terms of: why is treatment adherence so low, how do communities interact with HIV interventions. My work focuses on peer support and knowledge sharing for men at risk for and living with HIV/AIDS. I advocate that community members can provide the most knowledge when it comes to navigating streets rampant with treacherous HIV-stigma. As a result of this, I aim to facilitate and encourage platforms for knowledge sharing through peer interaction in ‘brave spaces’ that circumvent HIV stigma.

It seems to me that there are many discussions surrounding the ‘what’ when it comes to the world’s fights against HIV/AIDS. But if we are to win in this battle by 2020, we must begin brainstorming the ‘how’ and ‘why’ – before it is too late.

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